301 test 2 Flashcards
what can nutrition effect?
tissue integrity, sensory perception, and elimination
what can effect nutrition
hormonal regulation, elimination, glucose regulation, and sensory perception
people with burns are at risk for
hypovolemic shock
purpose of nutritional assessment
identify individuals who are malnourished/dehydrated or are at risk for development of calorie and liquid malnourishment.
what lab do we look at to assess nutrition
total protein= prealbumin, albumin, and globulin
normal albumin
3.5-5 gdL
what does albumin lab measure
circulating protein. can be impacted by fluid status and liver function
how long will it take to see fluctuations of albumin
3-4 weeks
prealbumin normal levels
15-36 mg/dL
what does prealbumin reflect
protein and calorie intake for the previous 2-3 days
normal levels of blood glucose
70-105 mg/dL
what does blood glucose reflect
carbohydrate metabolism
what can hgb/hct indicate in labs
can indicate anemia caused by low iron, folate and vitamin B12
what does the lipid profile show
reflects lipid metabolism
what can BUN/creatine ratio and urine specific gravity be used for?
to determine hydration status
normal range of BUN/ creatine ratio
20:1
Hemoglobin A1C
glucose levels over long period of time
what topics are included in present health history for nutrition assessment
chronic illness, medications, weight changes, food intolerances, street drugs or alcohol, problems obtaining eating food, weight concerns
what do alcohol and street drugs do to your nutrition
decrease nutritional absorption
what measures can be taken to correct weight concerns
diet and exercise modifications and surgery
methods of obtaining a diet history
24 hour recall, typical food intake, food diary, comprehensive diet history
nutritional exam includes
anthropometric measurements, inspections of skin, hair, and nails, inspections of eyes, inspection and palpation of the extremities bilaterally
BMI
body mass index, estimate of total body fat
triceps skin fold
evaluate subcutaneous fat stores
mid-arm muscle circumference
evaluate muscle reserve
how do you calculate BMI with inches and pounds
((weight in pounds/(height in inches x height inches)) X 703
BMI underweight
below 18.5
BMI normal
18.5-24.9
BMI overweight
25-29.9
BMI obesity class 1
30-34.9
BMI obesity class 2
35-39.9
BMI morbid obesity
40 and greater
BMI chart does not work on individuals who are
below 5 feet
BMI does not differentiate between
fat and muscle tissue
what happens with muscle mass in elderly
they tend to lose it
what should you add to BMI to increase predictability for health risk
waist circumference
calculate percent change in weight
current body weight/usual body weight X 100
calculate waist to hip ratio
pear shape vs apple shape
DBW
desirable body weight
normal DBW
(desirable body weight) normal is 90-110%
what happens with nutrition as you get older
physical limitations, decreased taste and appetite, muscle tone and mass decrease, loss of subcutaneous fat, become more salt sensitive, fat is redistributed
assessing hydration status
weight, skin turgor, pitting edema, skin moisture, tongue,lung sounds, blood pressure, urine output
malnutrition can be confused with what other diseases
anemia, hyper or hypothyroidism, hepatic disease, alcoholism, cancer, depression
obesity related conditions
obesity related conditions include heart disease, CVA, DM type 2 and certain types of cancer
what portion of America is obese
1/3
estimated annual cost of medical cost towards obesity
147 billion
obesity risk factors
sedentary lifestyle, high fat diet, genetics, ethnicity/race, female, age
reasons for undernutrition
acute illness, chronic disease, extreme age, alcohol abuse, depression, limited knowledge, physical inability, eating disorder, poverty, lifestyle
enteral feeding
tube feeding provided through a tube inserted into the nose to stomach, small-intestine, or gastrostomy
parenteral nutrition
when GI tract can no longer be used for digestion. can be IV fluids with dextrose or total parenteral nutrition
parenteral nutrition has high risk for
infection
PEG
percutaneous endoscopic gastronomy tubes
signs of fluid overload
weight gain, pitting edema, visible neck veins, crackling lung sounds, elevated pulse rate and blood pressure, SOB
new food guidance system in US
choose my plate includes 5 food groups. make half your plate fruits and vegetables and half your plate grains and protein
peritoneum
serous membrane forming protective cover of the abdominal cavity
peritoneum divided into what 2 layers
parietal and visceral
peritoneal cavity
space between the parietal and visceral layers, contains small amount of serous fluid to reduce friction
alimentary tract
27 feet long. ingest, digest, absorb nutrients, electrolytes, and water, and excrete waste product
what parts does the alimentary tract include
esophagus, stomach, small intestine, and large intestine
esophagus ph
6-8
stomach ph
2-4
chyme
breakdown and conversion of carbs, proteins, and emulsified fat that is liquified
what does chyme consist of?
peptones, amino acids, fatty acids, and glycerol
small intestine
largest section of GI tract includes duodenum, jejunum, and ileum
large intestine
about 5 feet. includes cecum, colon, rectum, and anal canal
liver functions
bile production, secretion to emulsify fat, transfer bilirubin, metabolism of proteins, carbohydrates, and fats, storage of glucose in form of glycogen, production of clotting factors and fibrinogen for coagulation, synthesis of plasma proteins, detoxification of substances, and storage of minerals and vitamins
plasma proteins
albumin and globulin
gallbladder
stores bile produced by liver and ducts drain bile into duodenum
bile in feces cause
the brown color
pancreas
produces endocrine secretions and exocrine secretions
endocrine secretions
insulin, glucagon, somatostatin, and gastrin
exocrine secretions
bicarbonate, pancreatic enzymes
spleen
filters antigens from the blood, important in response to systemic infections, activation of B and T lymphocytes, stores erythrocytes and platelets
kidneys
erythropoietin secretion for erythrocyte production, regulation of fluid and electrolyte balance, RAAS, production of active vitamin D
kidney location
T 12-L3
moderate distention of bladder
300 mL
level of discomfort of bladder
450 mL
arteries in abdomen
abdominal aorta, renal artery, and iliac artery
Right upper quadrant
liver, gallbladder, pylorus, duodenum, head of pancreas, right kidney, right adrenal gland, hepatic flexure of colon, portions of ascending and transverse colon
left upper quadrant
stomach, spleen, left lobe of liver, body of pancreas, left kidney, left adrenal gland, splenic flexure of colon, and portions of transverse and descending colon
left lower quadrant
portion of descending colon, sigmoid colon, left ureter, left ovary, left spermatic cord, bladder if distended, and uterus if enlarged
right lower quadrant
cecum, appendix, right ovary, right ureter, right spermatic cord, bladder if distended, and uterus if enlarged
GI in older adults
slowing of GI motility, increased likelihood of regurgitation, bacterial flora less active, increased food intolerance, decrease intestinal sphincter tone, bladder decreases in size and decrease in bladder muscle tone
what chronic illnesses should you ask about when assessing the GI/GU
DMII, renal failure, liver failure, hepatitis, gallbladder disease, HTN, cancer, Crohn’s, IBS/IBD, colitis, CVA, spinal issues, benign prostate hypertrophy
what family history should you ask about with GI/GU assessment
GERD, cancer of upper/lower GI, renal disease, bladder disorders and cancers, gall bladder disease
what could black stool indicate
bleeding internally due to ulcer or cancer
what could light color or white stool indicate
it could mean a bile duct obstruction
what could red stool mean
symptom of cancer
what could yellow stool mean
excess fat due to malabsorption
what can brown urine indicate
increased bilirubin
cola urine
rhabdomyolysis from muscle breakdown
order of assessment for GI/GU
inspect, auscultate, percuss, and palpate
urinary catheters should always be _____ than patient
lower
gastro
stomach
entero
intestine
colo
large intestine
procto
anus/rectum
hepato
liver
nephro
kidney
cysto or vesical
bladder
uro
relating to urine
itis
inflammation
lithiasis
formation of calculi
stomy
an artificial opening made into an organ through surgery
ectomy
surgically remove
scopy
to look or examine
fistula
an abnormal connection between an organ and another structure
rrhea
flow or discharge
uria
in the urine
GERD
gastroesophageal reflux disease. caused by weakened lower sphincter or increased abdominal pressure
findings with GERD
heartburn, regurgitation, dysphagia, often aggravated by lying down relived by sitting up antacids, eating, and mid epigastric pain with palpation
peptic ulcer disease risk factors
H. Pylori, NSAIDS, ASA, corticosteroids
peptic ulcer disease findings
burning pain in the LUQ/epigastric anywhere from 1-4 hours after eating
diverticulitis
inflammation of the diverticula. infectious
diverticulitis findings
increased temp, abdominal discomfort, bowel pattern alterations
hiatal hernias
stomach protrudes through esophageal hiatus in diaphragm
hiatal hernia findings
heartburn, regurgitation, dysphagia
crohn’s disease
mouth to anus. looks like cobble stones (called skip lesions)
clinical manifestations of Crohn’s disease
severe abdominal pain, cramping, diarrhea, blood or mucus in feces, constipation
ulcerative colitis
most common form of IBD, happens in colon. mucosa ulcerated. can progress to colon cancer.
what can cure ulcerative colitis
total colectomy
diseases of liver
hepatitis A,B,C and cirrhosis
hepatitis A
usually food-borne
hepatitis B
uncommon secondary due to immunization
hepatitis C
common. often undiagnosed, sometimes it doesn’t effect liver enzymes profoundly, leading cause of cirrhosis and liver transplant
steatohepatitis
fatty liver
cirrhosis
associated with alcohol intake. associated with malnutrition and vitamin B deficiency, alterations in CBC, coagulopathies
coagulopathies
blood’s ability to coagulate (form clots) is impaired
CBC
complete blood count
ascites
fluid accumulation associated with liver disease
cholecystitis with cholelithiasis
gallstones
gallstones
obstruction of the bile duct
cirrhosis findings
had palpable liver, ascites, jaundice, cutaneous spider angiomas, dark urine, tan stool, splenomegaly
risk factors for gallstones
female, fat, flatulent, forty
gallstones clinical finding
RUQ colicky pain that can radiate to right shoulder, indigestion, mild jaundice, nausea after eating high fat foods
pancreatitis
inflammation of the pancreas which causes auto digestion
primary cause of pancreatitis
alcohol, gallstones, pregnancy, prior pancreatitis
clinical findings of pancreatitis
sudden onset, LUQ can radiate to back, chronic, pain is deep, piercing, and heavy, weight loss, steatorrhea, tender abdomen, ascites, jaundice, hypotension, internal bleeding, shock, patient in fetal position
pyelonephritis
fever, flank, pain, dysuria, nocturia, and frequency
UTI clinical findings in older adults
fatigue, muscle aches, abdominal pain, shaky and weak, confusion, and delirium
clinical findings of UTI
frequency and urgency, dysuria, pyelonephritis
nephrolithiasis
kidney stones
risk factors for kidney stones
urinary stasis and infection
clinical findings of kidney stones
fever, hematuria, severe pain at costovertebral angle
types of bones
short, flat, irregular, long
compact bone
forms the shaft and outer layer
cancellous bone
makes up the ends and center
tendon
muscle to bone
ligament
bone to bone
fascia
band or sheet of connective tissue, primarily collagen, beneath the skin that attaches, stabilizes, encloses, and separates muscles and other internal organs.
function of cartilage
decrease friction
synovial
freely movable
nonsynovial
immovable
types of joints
hinge, gliding, and ball and socket
function of the joints
provide mobility to the skeleton
diathroidial
moveable joint
bursa
fluid filled sac that can form with friction
how many cervical vertebrae do we have?
7
how many thoracic vertebrae do we have
12
how many lumbar vertebrae do we have
5
inversion
sole of the foot towards the median plane
eversion
sole of foot away from the median plane
protraction
anterior movement
retraction
posterior movement
opposition
movement of thumb towards a finger or palm to grasp something
ottawa fracture rules
if you can walk the ankle its probably no broken
if joint is not aligned it may be
dislocated
what does obesity do to the joints
puts extra strain and stress on the joints, which can increase the risk of degenerative joint disease
if someone has a problem with there left side, what side would you look at first
right to get a feeling of what normal looks like
what do you asses when a patient ambulates
do their arms swing? assess their gait
strength scale
0/5 strength- none, 1/5 strength- trace, 2/5 strength- poor, 3/5 strength - fair, 4/5 strength - good, 5/5 - full
line between iliac crests crosses what spinous process
L4
what spinous process is at the bottom of you scapula
T7
which part of your spine should curve posteriorly
thoracic and sacral
which part of your spine should curve anteriorly
cervical and lumber
Scoliosis and who gets its?
side-to-side spinal curves. On an X-ray, the spine of an individual with scoliosis looks more like an “S” or a “C” than a straight line. scoliosis runs in families. it usually develops in childhood but can occur in adults and elderly.
radiculopathy
referred pain. pain that is causing/radiating somewhere else
herniated disk
Normal wear and tear over time can cause one of the disks in your spine to rupture also called a “slipped” disk. Compression or inflammation of the sciatic nerve causes sciatica — a sharp, shooting pain in the lower back, buttocks and leg.
what is sciatica hard to diagnose
each nerve has a sensory portion for skin sensation, pain, and muscle feedback. There is also a motor portion for muscle control and strength. This adds to the complex nature of diagnosing sciatica
vagus
knocked knees and usually obese
varus knees
bowed and usually skinny
Ballottement
physical exam of knee: With the patient supine and the knee extended, press on the quadriceps muscle just above the knee with one hand and keep that pressure there. Palpate the patella with the other hand feeling for fluid.
effusion
fluid on the joint
Bulge Test
physical exam of knee: Differentiates soft tissue swelling from accumulation of fluid behind the patella.
Drawer Sign
With patient supine flex the knee to a right angle. While standing at the at the patient’s feet, grasp the leg just below the knee and see if you can move it toward and away from self
some abnormal findings with MSK
TMJ dysfunction, gout, OA, RA, osteoporosis, sprains, fractures, injuries
TMJ
temporalmandibular joint. permits chewing and speaking, protraction and retraction, and gliding from side to side
gout
form of arthritis caused by excess uric acid in the bloodstream. mostly in men. strongly correlated with alcohol, obesity, HTN, diuretic use
osteoarthritis
hard contender nodules. can be heberden’s or Bouchard’s nodes
risk factors of osteoarthritis
inactivity, overactivity, obesity, repeated injuries, being over 45
Heberden’s nodes
Osteophytes of the distal interphalangeal joints
Bouchard’s nodes
Osteophytes of the proximal interphalangeal joints
osteoporosis
Decreased bone mass. old bone is not replaced as fast with new bone. Bones become weak, spongy and can break easily. osteoporotic bone looks more porous
risk factors for osteoporosis
woman, caucasian or asian, family history, decreased weight, smoking/drinking, steroids
what is the screening for osteoporosis?
the Dexa scan
how can osteoporosis cause back pain
If you have osteoporosis, daily lifting and other routine activities can cause low back pain by fracturing the front part of the weakened bones, these are known as compression fractures
rheumatoid arthritis
(RA) autoimmune, lab diagnosis, hereditary
kyphsis
hump back
lordosis
A curving inward of the lower back
who has the highest risk of developing problems from loss of bone density
caucasian woman
what do you do during the acute phase (such as fall or injury)?
assess first! do not move them! unless CPR is needed
left hip fracture dislocation
Affected extremity exhibits external rotation and is short compared to the unaffected leg. pain will occur when rotating the leg
tinel’s test
physical exam of hand: Evaluates for carpel tunnel syndrome. Percuss lightly over the median nerve located on the inner aspect of the wrist.
phalen’s test
Evaluates for carpel tunnel syndrome. Flex wrists 90 degrees and hold the backs of the hands to each other for 60 seconds.
